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A Pilot Study

Barbara Gerbert, PhD; Amy Bronstone, PhD; Toby Maurer, MD; Roger Hofmann; Timothy Berger, MD

Arch Dermatol. 2000;136:187-192.

Objective  To determine whether decision support software can help primary care physicians proficiently triage lesions suggestive of basal cell and squamous cell carcinoma.

Design/Measures  Physicians selected triage options for 15 digitized images of skin lesions, with and without use of the decision support software.

Participants/Settings  Twenty primary care physicians practicing in a health maintenance organization or a city health clinic.

Intervention  Decision support software designed to help physicians arrive at a triage recommendation consisted of a clinical information form, a decision tree, and support features (teaching points, example images, and diagrams).

Results  Without using the decision support software, physicians chose the wrong triage decision 36.7% of the time; using the decision support software, they chose the wrong response only 13.3% of the time. Not using the decision support software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions 22.1% of the time; using the software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions only 3.6% of the time. Physicians scored an average of 3 points (of a possible 15 points) higher when they used the software (signed rank, 101.0; P<.001). They scored an average of 1 point higher on the 7 cancerous lesions when they used the software (signed rank, 65.5; P<.001).

Conclusions  Use of decision support software could improve primary care physicians' triage decisions for lesions suggestive of nonmelanoma skin cancer, and potentially reduce morbidity and health care costs. We are designing a larger study to evaluate the accuracy and utility of the software with patients seen in clinical practice.

From the Division of Behavioral Sciences, School of Dentistry (Drs Gerbert and Bronstone), and Department of Dermatology, School of Medicine (Drs Maurer and Berger), University of California, San Francisco; and West Portal Software Corp, San Francisco (Mr Hofmann).

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